tbuckley/cabot-search huggingface dataset:
Abstract 13660: Lp(a) is Associated With Coronary Artery Calcification in a Population With Exceptionally Low Cardiovascular Disease Risk
Authors: Benjamin C Trumble, Randall C Thompson, Caden A Elizalde, Michael Miyamoto, Jonathan Stieglitz, Samuel S Wann, Adel Allam, Chris Rowan, Daniel Cummings, M Linda Sutherland, James Sutherland, Daniel Eid Rodriguez, David E Michalik, Guido Lombardi, Edward Seabright, Sarah Alami, Angela R Garcia, Bret Beheim, Paul Hooper, Caleb Finch, Kenneth Buetow, Michael Gurven, Hillard Kaplan, Gregory S Thomas
Journal: Circulation (2022)

Introduction: The Tsimane forager-horticulturalists of Bolivia are highly physically active, carry high infectious disease burdens, and have the lowest reported population levels of coronary artery calcium (CAC), as well as relatively low cholesterol (LDL, HDL, total) levels. In industrialized populations, lipoprotein(a)—Lp(a)— is strongly predictive of coronary artery and aortic valve calcification (AVC). However, these relationships have not been assessed in this non-urban population. Hypothesis: We hypothesize that, despite the very low levels of CAC seen in the Tsimane, Lp(a) is higher in those with CAC and AVC but overall lower in Tsimane compared to a US comparator population (CARDIA). Methods: CAC and AVC were measured by non-contrast cardiac CT in 917 Tsimane (15.5% CAC positive, 21.0% AVC positive). A subset of 98 Individuals with and without CAC or AVC had serum Lp(a) analyzed (median age 63 yrs, range 41-91 yrs, 67% male) using a standard double monoclonal antibody ELISA at the Northwest Lipid Metabolism and Diabetes Research Laboratory (University of Washington). Individuals with CAC and AVC were oversampled (45.9% CAC positive, and 76.7% with AVC; 10% with neither) to ensure statistical power. Results: Overall, Tsimane had significantly lower levels of Lp(a) than CARDIA white males (Tsimane male median 16.5 nmol/L vs US median 19.4 nmol/L; p&lt;0.001) and CARDIA white females (Tsimane female median 11.5 nmol/L vs US median 21.9 nmol/L; p&lt;0.001), despite oversampling Tsimane with CAC and AVC. While Tsimane Lp(a) was low, individuals with CAC had significantly higher Lp(a) (p=0.030) controlling for age, sex, and body fat. Tsimane with no CAC had a median Lp(a) of 12.2 nmol/L, while those with any CAC signal had a median Lp(a) of 17.7 nmol/L. There was no association between AVC and Lp(a). Conclusions: While the Tsimane have lower levels of both CAC and Lp(a) than US adults, Lp(a) is significantly higher in Tsimane with CAC. The absence of association between Lp(a) and AVC may indicate that among the Tsimane, the etiology of AVC may be less tied to Lp(a) than in industrial populations. These results suggest that Lp(a) is associated with arterial calcification even in patients with low overall cardiovascular disease risk.
Abstract 14544: Association Between Employment Status and Occupational Groups With Prevalent Hypertension in Working-Age Adults in the United States in 2020
Authors: Amna Aijaz, Tarang Parekh, Kobina Hagan, Onoriode Kesiena, Zulqarnain Javed, Aysha Allahverdiyeva, Jacob Braunstein, Khurram Nasir
Journal: Circulation (2022)

Introduction: Hypertension remains a strong risk factor for cardiovascular disease Besides established risk factors for hypertension, socioeconomic determinants including employment status and occupation are now emerging. With unemployment rates peaking in the US in 2020, we examined the burden of hypertension by employment status and occupation type. Methods: Data from the National Health Interview Survey (NHIS) 2020 was used to study the association of hypertension and employment status and hypertension and occupation groups using logistic regression. Adults aged 18 years and older residing in the US were included in the sample. A subgroup analysis was conducted among those aged 65 years and younger to assess if there was a difference if the model excluded most retired individuals. Results: We studied 28,973 US adults and the overall prevalence of hypertension was 24.7%, with significant differences amongst all subgroups except for sex. The adjusted odds of having hypertension was 0.64 (0.59, 0.70) times among employed adults compared to the unemployed. All occupation groups had significantly lower adjusted odds of hypertension than the unemployed, ranging from OR = 0.41 (0.33, 0.52) for Natural Resources, Construction, and Maintenance Occupations to OR = 0.78 (0.64, 0.94) for Healthcare Practitioners and Technical Occupations. A subgroup analysis amongst those aged 65 years and younger was not significantly different from the main model. Conclusion/Significance: Employment was associated with reduced odds of hypertension. All occupation groups were associated with reduced odds of hypertension compared to the unemployed. Further studies are needed controlling for more confounders (such as work life balance, shift work), studying these associations prospectively and retrospectively. Studies among higher risk occupations identifying job related factors associated with hypertension could guide relevant policy actions.
Abstract 13710: Acute Beneficial Effects of a Rho-Kinase Inhibitor, Fasudil in Patients With Pulmonary Hypertension Due to Left Heart Disease
Authors: Masaki Ishiyama, Naoki Fujimoto, Toru Sato, Taku Omori, Keishi Moriwaki, Emiyo Sugiura, Yoshito Ogihara, Shiro Nakamori, Tairo Kurita, Kaoru Dohi
Journal: Circulation (2022)

Introduction: The prognosis of reactive pulmonary hypertension (PH) due to left heart disease is poor, and the pathogenesis of the disease is not well understood. Rho-Kinase inhibitor, fasudil dilates vascular smooth muscle and may improve pulmonary hypertension. We evaluated the acute effects of fasudil on hemodynamic parameters in patients with pulmonary hypertension due to left heart disease prospectively. Methods: From 2016 June to 2022 May, 100 consecutive patients requiring hospitalization for worsening chronic heart failure were enrolled. All patients underwent invasive hemodynamic measurement though right heart catheterization.In patients with mean pulmonary arterial pressure greater than 25 mmHg at baseline, 30 mg of fasudil was administered intravenously for 30 minutes. The hemodynamic measurements were performed at baseline and after 30 minutes of fasudil. PH due to left heart disease is defined as mean pulmonary arterial pressure (mPAP) ≥25mmHg and mean pulmonary capillary wedge pressure (mPCWP) &gt;15mmHg. Patients with PH were classified into 2 types, depending on the elevation of pulmonary vascular resistance (PVR) or the diastolic pressure gradient (DPG): Reactive-PH with elevated PVR (&gt;3.0 Wood units: WU) and/or DPG (&gt;7mmHg), and Passive-PH with normal PVR (≤3.0 WU) and DPG (≤7mmHg). Results: Fifty patients (mean age 70 years; 14 women and 36 men) received administration of fasudil. 30 patients had Passive-PH, and 20 patients had Reactive-PH. PVR significantly decreased after administration of fasudil in both Passive-PH and Reactive-PH group (1.7 to 1.4 WU, 3.5 to 2.7 WU, P&lt;0.001). The rate of change in PVR after administration of fasudil was significantly higher in the Reactive-PH group compared to the Passive-PH group (33% vs 21 %, P&lt;0.05). mPAP and cardiac index significantly improved in both Passive-PH (34±8.5 vs. 28±8.2 mmHg, 2.7±0.7 vs. 2.9±0.8 l/min/m 2 , p&lt;0.05) and Reactive-PH group (41±7.9 vs. 33±9.0 mmHg, 2.2±0.6 vs. 2.4±0.6 l/min/m 2 , p&lt;0.05). Mean blood pressure and arterial oxygen saturation were unaffected by fasudil (87 to 84 mmHg, 99 to 90 mmHg, 98 to 97%, 97 to 97%, not significant). Conclusions: Fasudil improves pulmonary hypertension due to left heart disease without any detrimental effects on hemodynamics.
Abstract 13772: The Cardiac Autonomic Reactivity in Long-Term Female Yoga Practitioners: A Comparison With Runners and Sedentary Individuals
Authors: Jia-Ru Lin, Pei-Tzu Wu, Wen-Lan Wu, Yu-Kai Chang, I-Hua Chu
Journal: Circulation (2022)

Introduction: Yoga practice, a means of stress management, has been reported to optimize psychophysiological health; however, its underlying mechanisms remain unclear. The purpose of the present study was to examine the cardiac autonomic reactivity in long-term yoga practitioners and compared that to runners and sedentary individuals. Hypothesis: The level of cardiac autonomic reactivity in yoga practitioners would be greater than that in the sedentary individuals but similar to that in the runners. Methods: Female individuals aged 20-50 years old with BMI 18.5-30 kg/m 2 were recruited. Participants in the yoga (or running) group regularly performed yoga (or running) for ≥ 90 minutes/week, for at least 2 years. Participants who did not regularly perform any type of physical activity were assigned to the sedentary group. Blood pressure (BP), heart rate (HR), respiration rate (RR) and heart rate variability (HRV) parameters (e.g., high frequency normalized unit (HFnu), the square root of the mean squared differences of successive normal-to-normal intervals (RMSSD), total power (TP) and standard deviation of normal-to-normal (SDNN)) were recorded at rest, during and following psychological stress, which was elicited by the Stroop color-and-word test (SCWT) and the mental arithmetic task (MAT). Outcome variables in the 3 groups were compared at multiple phases using Group x Time mixed design ANOVA and Bonferroni post-hoc comparison. Results: Yoga group demonstrated a lower RR (10.4±2.1 bpm) as compared to the other 2 groups, and a lower HR (66.6±7.6 bpm) and diastolic BP (67.8±8.4 mmHg) at rest as compared to the sedentary group (all p&lt;0.05). HFnu following mental stress returned to the baseline in yoga (35.7±16.0 vs. 43.5±20.5) and running groups (44.7±17.1 vs. 52.0±18.0), but not in the sedentary group (29.9±22.0 vs. 43.1±18.3, p&lt; 0.05). Similar results were observed in RMSSD and TP, where the level of outcome variables at the recovery phase returned to baseline in the yoga and running group, but not in the sedentary group. Conclusions: Yoga practitioners may have a greater homeostatic capacity and autonomic resilience than do sedentary individuals. The level of autonomic reactivity in long-term yoga practitioners was similar to that in the runners.
Abstract 13840: Impact of Age and Variant on Cardiovascular Events Among Patients Hospitalized With COVID-19: An Analysis From the AHA COVID-19 CVD Registry
Authors: Pratyaksh K Srivastava, Alexandra M Klomhaus, David M Tehrani, Boback Ziaeian, Asim Rafique, Pooja S Desai, Gregg C Fonarow, James A De Lemos, Rushi Parikh, Eric H Yang
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic has caused significant cardiovascular (CV) morbidity and mortality. Using a national registry, we evaluate the impact of age and variant on CV outcomes across the three main coronavirus waves. Methods: Using the AHA’s COVID-19 CV Disease Registry, we divided patients hospitalized with COVID-19 into three groups based on dominant variant at the time of admission (Alpha, Delta, Omicron). We further stratified patients based on age (young: 18-40, older: &gt;40 years). Using adjusted logistic regression, we compared rates of major adverse cardiovascular events (MACE: new onset heart failure, myocardial infarction, stroke, or death) and in-patient mortality between the groups. Results: There were 41,426 patients in the alpha wave (young: 5,585, older: 35,841), 3,349 patients in the delta wave (young: 690, older: 2,659), and 646 patients in the omicron wave (young: 213, older: 433). The cohort’s median (25 th -75 th %ile) age was 63 (50-75) years. 46.8% of the patients were female. Rates of MACE in the Alpha, Delta, and Omicron waves were 20.8%, 23.6%, and 15.5%. Rates of death were 14.0%, 14.8% and 6.0%, respectively. Compared to alpha, patients presenting during delta had increased odds of MACE and death (OR: 1.57 [1.42-1.73] and OR: 1.49 [1.34-1.66]). Patients presenting during omicron had decreased odds of death (OR: 0.6 [0.43-0.84]) and similar odds of MACE compared to alpha. When stratifying by age, both young and older patients presenting during delta had increased odds of MACE and death when compared to alpha (Fig 1A). When compared to young patients, older patients had increased odds of MACE in all three waves (Fig 1B). Conclusions: Patients had increased odds of MACE and death during delta compared to alpha. Compared to young patients, older patients had increased odds of MACE across all three waves. These findings help elucidate the differential impact of age and variant on cardiovascular outcomes among those hospitalized with COVID-19.
Abstract 14648: Can GRACE Risk Score Predict Mortality in Pulmonary Embolism?
Authors: esra donmez, Sevgi Ozcan, Murat Ziyrek, Irfan Sahin, Ertugrul Okuyan
Journal: Circulation (2022)

Introduction Risk stratifying of pulmonary embolism (PE) patients and treatment for normotensive patients is still challenging. We aimed to assess the utility of GRACE risk score for 30-day mortality. Methods All consecutive patients hospitalized with a diagnosis of PE between2016 -2021 were included in this retrospective study. GRACE and PESI scores were calculated online. Results A total of 197 patients were enrolled. Mean age was 63.98±15.51. 56 of patients died by the end of the 30-day. When patients divided into 2 groups according to 30-day mortality, both groups were similar in terms of gender, hypertension, diabetes mellitus, coronary artery disease, heart failure and chronic obstructive pulmonary disease. Troponin level (212.4± 24.6 vs. 850.8±231.1; p&lt;0.0001), PESI (122.3±27.2 vs. 170.1±49.1; p&lt;0.0001) and GRACE (127.1±28.8 vs. 182±21.3; p&lt;0.0001) were significantly higher in non-survivor group. The correlation analysis we observed strong positive correlation between PESİ and GRACE (r=0.732; p&lt;0.0001). Regression analysis revealed that only GRACE score [p=0.021, β: 1.146, OR (95% CI): 1.021-1.286] was an independent risk factor associated with 30-day mortality. ROC curve for accuracy of GRACE score for predicting 30-day mortality in PE patients is shown in figure 1. Area under curve (AUC) for GRACE score was 0.969 [%95 CI: 0.948-0.990]. A cut off value of 161.5 for GRACE score was associated with 90.0% sensitivity and 89.7% specificity in prediction of 30-day mortality. Conclusion In this study, the relation between GRACE score and the clinical course of PE patients evaluated and we found GRACE risk score as an independent risk factor associated with 30-day mortality and strong correlation between GRACE and PESİ risk scores. To predict the mortality of high-risk normotensive and hypotensive PE patients,GRACE risk score exhibited high specificity and positive probability.
Abstract 13174: Cardio-Metabolic Traits of a Heart Failure With Preserved Ejection Fraction Mouse Model
Authors: Paola C Rosas, Shamim Chowdhury, Shreya B Kurup, Nisha A Patel
Journal: Circulation (2022)

Introduction: Heart failure with preserved ejection fraction (HFpEF, EF&gt;50%) syndrome is often associated with hypertension, hyperlipidemia, obesity, and diabetes. Morbidity and mortality in patients with HFpEF are similar to those with heart failure with reduced ejection fraction, however therapies are scarce. Mouse models used to understand sarcomere dysfunction in HFpEF and to identify new targets are needed. In this study we challenged young mice with volume overload and metabolic perturbations induced by high fat diet (HFD) to harbor the conditions of HFpEF. Methods: C57BL/6N 16-weeks old female and male mice were treated with subcutaneous pellets of controlled released DOCA (Deoxycorticosterone Acetate, 0.71 mg/d), drinking water with 1% saline and HFD for a period of 3 weeks to induce obesity and mild hypertension. Cardiac function was evaluated at baseline (before treatment) and 2 and 3 weeks after treatment. Body weight, % fat mass, %lean mass, glucose tolerance test, and lipid profile were also evaluated at baseline and 3 weeks after treatment. Results (Table): Treatment induced diastolic dysfunction measurable by echocardiography at 3 weeks with slower peak myocardial relaxation velocity (e’), increased peak blood inflow velocity at early diastolic filling E/e’ ratio, increased E/A ratio, and increased isovolumetric relaxation time (IVRT). Meanwhile ejection fraction is preserved. As expected HFD feeding elicited body weight increase with increased fat mass accumulation associated with decreased lean mass, glucose intolerance and hypercholesterolemia. Conclusions: This study describes a mouse model of HFpEF that only requires 3 weeks of treatment with DOCA, 1% saline drinking water and HFD. This model reproduces the most common comorbidities of HFpEF such as diastolic dysfunction, obesity, glucose intolerance, and hypercholesterolemia, and may be used to understand the molecular pathophysiology of HFpEF.
Abstract 13842: Changes in Patient Selection and Outcomes in the New Heart Transplant Allocation Era
Authors: Ritchelli Quintao, Khaled Shorbaji, Brett Welch, Arman Kilic
Journal: Circulation (2022)

Objectives The adult heart allocation policy in the United States was changed in October 2018. This study evaluates changes in patient selection and outcomes of heart transplantation over the past 3 years under this new policy. Methods: The United Network for Organ Sharing database was queried for adults undergoing isolated heart transplantation under the new allocation system between October 18, 2018 to September 25, 2021, with follow-up through September 2021. To evaluate temporal changes, the study cohort was divided at the midpoint of the study period to define early and late groups. Kaplan-Meier and multivariable Cox proportional hazards models were used for unadjusted and risk-adjusted analyses, respectively. Results: A total of 6,485 adults underwent heart transplantation in the new allocation era (2,746 early, 3,739 late). A comparison of recipient, donor, and transplant characteristics demonstrated that patients in the latter half were older, more likely blood type O, underwent durable LVAD bridging more frequently, were in the intensive care unit prior to transplant less frequently, had a higher proportion of bridging with Impella devices and lower proportion of bridging with intra-aortic balloon pumps. Donors of patients in the latter half more likely had drug overdose as the mechanism of death and more frequently had diabetes. Unadjusted and risk-adjusted 1-year survival were similar between early and late patients. Center-level analysis demonstrated that 44.6% of centers had better 1-year survival rates, 33.7% had worse, and 21.7% had similar in the latter half (Figure 1). Conclusion There have been several changes in recipient and donor characteristics in heart transplants performed in the latter half of the new allocation era although post-transplant outcomes remain similar across the study period. Figure 1 Change in center 1-year mortality rates after policy change.
Abstract 14580: Electrocardiographic Machine Learning to Identify Elite Endurance Male Athletes: Chief Heart Study
Authors: Gen-Min Lin
Journal: Circulation (2022)

Background: Several electrocardiographic (ECG) features have been identified for athlete’s heart. However, it is unknown whether using machine learning for ECG features could identify the elite athletes. Methods: In a large population of 2,296 physically active military males, aged 17-43 years, three machine learning classifiers including logistic regression (LR), multilayer perceptron (MLP), and support vector machine (SVM) for 26 ECG features (axis, duration and voltage of P, QRS and T waves in each lead) and 6 biological features (age, anthropometrics, blood pressure and pulse rate) were used to identify the elite athletes from the study population. Elite athletes were defined as those who had the top 10% performance in a 3000-meter run test (with a mean time of 747 sec) and the remaining 90% were as the control group (with a mean time of 871 sec). The data of the 2,296 participants were randomly grouped by a 3:1 ratio into a training/validation set (N =1,607) and a test set (N =689). Results: The area under the receiver operating characteristic curve (ROC) from the best to the worst performance of the three machine learning classifiers were listed in order: the LR (80.81%), followed by the MLP (78.43%), and the SVM (63.30%) (Figure 1). If the specificity is set around 70.0%, the sensitivity of the LR and MLP is estimated to 81.82%. Conclusions: This study suggests that it is feasible to utilize machine learning for ECG and biological features to identify the elite athletes. The proposed MLP and LR methods could provide acceptable detection ability for elite athletes and may be helpful to monitor the physical training status for athletes.
Abstract 13166: Proteomic Pathways Across Ejection Fraction Categories in Heart Failure: An Exscel Substudy
Authors: Anthony E Peters, Maggie Nguyen, Jennifer Green, Ewan Pearson, John Buse, Harald Sourij, Adrian F Hernandez, Naveed Sattar, Rury Holman, Robert J Mentz, Svati H Shah
Journal: Circulation (2022)

Background: Ejection fraction (EF) is a key component of heart failure (HF) categorization, including the newly-proposed HF with mildly reduced EF (HFmrEF) category. The biologic basis of HFmrEF, as an entity distinct from HF with preserved EF (HFpEF) and reduced EF (HFrEF), has not been substantiated. Methods: The EXSCEL trial randomized participants with type 2 diabetes to once-weekly exenatide (EQW) vs. placebo. In participants with prevalent HF, we profiled ~5000 serum proteins. Principal component analysis (PCA) and ANOVA (FDR p&lt;0.1) were used to determine differences in factors and individual proteins between three EF groups, as documented in EXSCEL (EF&gt;55% [HFpEF], EF 40-55% [HFmrEF], EF&lt;40% [HFrEF]). Cox proportional hazards was used to assess relationships between baseline proteins and changes in protein level with incident HF hospitalization. Results: Of 1199 EXSCEL participants with prevalent HF, 284 (24%), 704 (59%) and 211 (18%) had HFpEF, HFmrEF and HFrEF, respectively. Eight PCA protein factors and 221 individual proteins within these factors differed significantly across the 3 groups. Levels of the majority of proteins (83.3%) demonstrated concordance between HFmrEF and HFpEF, but higher levels in HFrEF, including the domain of extracellular matrix, e.g. COL28A1, tenascin C [TNC]; p&lt;0.0001. A minority of proteins (1%) were concordant between HFmrEF and HFrEF including matrix metalloproteinase-9 (p&lt;0.0001). Baseline levels of 94% of the 221 significant proteins were associated with incident HF including domains of extracellular matrix (COL28A1, TNC), angiogenesis (ANG2, VEGFa, VEGFd), myocyte stretch (NTpro-BNP), and renal function (cystatin-C). Change in levels of 18 of these proteins from baseline to 12 months (including increase in TNC) predicted subsequent HF (p&lt;0.05). TNC levels were reduced by EQW compared with placebo (p&lt;0.0001). Conclusions: In this large clinical trial, we found that most proteins were similar between HFmrEF and HFpEF. A key ECM protein, tenascin C, showed this relationship, and baseline level and change in tenascin C predicted HF and changed beneficially with EQW. These results suggest that HFmrEF is more biologically similar to HFpEF and highlight prognostic and modifiable biomarkers that vary by EF.